Colorectal Cancer Mortality Lower With Medicaid Expansion

Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) was associated with a lower overall mortality hazard among adults with colorectal cancer, according to a retrospective cohort study published in JAMA Network Open.

Investigators analyzed National Cancer Database data from 658,593 adults aged 40 to 64 years who were newly diagnosed with colorectal cancer from 2006 through 2021. A difference-in-differences design compared outcomes in expansion and nonexpansion states during the pre-ACA period of 2006 through 2013 and the post-ACA period of 2014 through 2021. Overall mortality was the primary outcome.

Medicaid expansion was associated with a 6.3% relative reduction in overall mortality hazard compared with nonexpansion (hazard ratio [HR], 0.94; 95% CI, 0.93-0.95). The largest association was observed among Hispanic patients, with a 22.6% relative reduction (HR, 0.77; 95% CI, 0.75-0.80). Smaller reductions were observed among non-Hispanic Black and White patients, while the association was not statistically significant among patients categorized as another race or ethnicity.

Associations with lower mortality were observed across all disease stages and were greatest in stage IV disease (HR, 0.88; 95% CI, 0.83-0.94). Expansion was also associated with a 2.13-percentage-point increase in early-stage diagnosis and a 1.54-percentage-point increase in surgical treatment. The investigators said these changes were consistent with, but did not establish, earlier detection and improved access to definitive care as explanatory mechanisms.

The observational design remained vulnerable to residual confounding. The hospital-based database may limit generalizability, and it lacked detailed information on treatment sequence, adherence, and tumor biology. The study was also restricted to adults aged 40 to 64 years. The authors concluded that Medicaid expansion was associated with improved colorectal cancer survival, while noting persistent differences among patient populations.

Source: Akinyemi O, Oyebanji O, Oluborode B, et al. Medicaid expansion and mortality among patients with colorectal cancer. JAMA Netw Open. 2026;9(9):e2634827. doi:10.1001/jamanetworkopen.2026.34827